Jennifer Murphy MBBCh, MRCPI, Presenter: Nothing to Disclose

Patrick Nicholson MBBCh, Abstract Co-Author: Nothing to Disclose

Karl James MBBCh, MRCS, Abstract Co-Author: Nothing to Disclose

Kevin Noel O Regan MD, Abstract Co-Author: Nothing to Disclose

Marie Staunton MBBCh, Abstract Co-Author: Nothing to Disclose

Initial results from the National Oncologic PET registry have demonstrated that 18F-fluoride PET/CT altered management in patients with prostate cancer in at least 44-52% of cases. We aim to critically appraise the literature to evaluate the use of 18F-fluoride PET/CT in the detection of bone metastases in patients with known malignancy.

A focused clinical question was constructed and the literature was searched using the patient, intervention, comparison, outcome (PICO) method. Our search strategy utilized a “top-down” approach of the evidence pyramid hierarchy. Information systems, synopses, syntheses and primary studies were reviewed. A search of Medline using PubMed “Clinical Queries” retrieved 2 meta-analyses. A PubMed PICO search retrieved 76 abstracts. Expert Consensus Guidelines, review articles, abstracts, editorials and case reports were excluded. Retrieved articles were appraised and assigned a level of evidence based on the Oxford University Centre for Evidence-Based Medicine hierarchy of validity for diagnostic studies.

The results corresponding to the highest level of evidence retrieved were two meta-analyses of cohort studies (level 1a). The retrieved diagnostic performance for 18F-fluoride PET or PET/CT showed sensitivity and specificity values of 96.2% [95% confidence interval (CI) 93.5–98.9%] and 98.5% (95% CI 97.0–100%), respectively, on a patient-based analysis and 96.9% (95% CI 95.9–98.0%) and 98.0% (95% CI 97.1–98.9%), respectively, on a lesion-based analysis. This compares with sensitivity and specificity values of 56.9% [95% CI 51.0–62.7%] and 98.0% (95% CI 96.4–99.6%), respectively, on a patient-based analysis and 55.7% (95% CI 50.7–60.7%) and 95.6% (95% CI 93.2–98.1%), respectively, on a lesion-based analysis for planar bone scintigraphy (BS) or planar BS plus SPECT. Dose and cost-effectiveness ratio were considerably higher for 18F-fluoride PET/CT than for BS.

18F-fluoride PET/CT has better sensitivity and similar specificity for the detection of bone metastases than planar BS or planar BS plus SPECT. However, radiation dose and cost-effectiveness must be considered.

A critical appraisal of the literature demonstrates that 18F-fluoride PET/CT has better sensitivity than planar BS or planar BS plus SPECT in the detection of bone metastases.

Murphy, J, Nicholson, P, James, K, O Regan, K, Staunton, M, 18F-fluoride PET/CT in the Detection of Bone Metastases: A Critically Appraised Topic.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14009688.html